The following are the highlights of the Champlain Local Health Integration Network Board of Directors meeting held in Ottawa, Ontario on July 26, 2017.
Medical Assistance in Dying in the Champlain Region - Overview
Two local experts provided the Board with an overview: Dr. Viren Naik and ethicist Mike Kekewich, both from The Ottawa Hospital, spoke about current medical assistance in dying (MAiD) processes in the region and recommendations for the future.
|Dr. Naik addresses the LHIN Board
Medical Assistance in Dying became legal in Canada in June 2016. It was noted that health-care providers have made significant efforts in ensuring effective and responsive provision of the new service to patients in the Champlain region. When discussing the essence of the MAiD legislation, Dr. Naik said, “This is not about the provider – it really is about the patient and their experience.”
Data provided by the Coroner’s Office shows that between June 17, 2016 and June 30, 2017, there have been approximately 550 medically assisted deaths in Ontario:
- They occurred in the following settings: 55% in hospitals, 35% in private residences, 6% in long-term care homes, 3% in retirement homes/seniors residence
- The average age of the patient was 73—53% were men and 47% were women.
- They were suffering from the following conditions: 65% cancer, 15% neurological, 11% circulatory/respiratory, 7% other cause.
- Of these, available data shows that there were between 61 and 78 medically assisted deaths in the Champlain region.
In this region, The Ottawa Hospital has been a lead organization for MAiD. The hospital has also been the provider in the majority (46) of these cases, including supporting 17 patients in the community, including in patients’ homes and retirement homes.
Mr. Kekewich explained to the Board that The Ottawa Hospital decided early on to add a social work component to its provision of this service. “This isn’t legally required, but we wanted to provide social-psychological support to patients and their families who are working through this process,” he said. Currently, such support is available for patients who are in the hospital setting. The goal is to expand it to patients and families who are in community settings.
Going forward, the presenters recommended the creation of a regional care-coordination service for MAiD to:
- Improve access for patients, and health system navigation for families
- Identify and leverage regional resources, and improve coordination among hospitals, long-term care homes, retirement homes, and community providers
- Improve education and support for health-care providers who participate in MAiD
- Facilitate collection of regional data for quality-improvement and future planning.
Champlain LHIN CEO Chantale LeClerc indicated that the LHIN has provided funds to The Ottawa Hospital for it to:
- Work with partners to develop an approach to coordination of MAiD in our region, and
- Propose a model for bereavement support for those with a loved one who chose to access MAiD.
Champlain LHIN Vice-President Catherine Butler told the Board that the LHIN’s Home and Community Care staff are providing support to patients, families and providers looking for information about MAiD. Other ways the LHIN supports access to MAiD include referrals, assessments, service coordination, and clinical support on the day of service.
The LHIN also has an internal MAiD oversight committee with ethics, clinical care and quality components. The oversight committee has audited each of the 24 cases of MAiD where the LHIN was directly involved. To date, there have not been any problematic issues.
Health professionals who provide this service need additional support, and the LHIN is actively working with them to determine their needs. Examples of those supports could include:
- Mindfulness-based stress reduction for health professionals
- Formal psychological debrief and team-based support
- Rotation of roles to give staff longer breaks between cases.
Board Chair Jean-Pierre Boisclair thanked the presenters for the overview, and most importantly, for their leadership and collaboration on this important and sometimes difficult topic. “We look forward to ensuring that people in the Champlain LHIN get the information and support they need, and that the process works for them,” he said.
Results of LHIN-Initiated Study on Child & Youth Health Services Capacity
Recently, LHIN CEO Chantale LeClerc approached the Children’s Hospital of Eastern Ontario (CHEO) / Ottawa Children’s Treatment Centre (OCTC), and asked the organization to lead a capacity planning project on the needs of children and youth in our region. Specifically, what are their health needs, are we doing a good job of meeting those needs, and where can we improve?
The result was a report entitled THRIVE: The Future of Integrated Health Service Planning for Children & Youth in the Champlain Region. Alex Munter (CEO of CHEO/OCTC) spoke briefly to the Board before introducing the project co-chairs. “We need to start by acknowledging the Champlain LHIN. This is the first and only LHIN that has taken on a study that looks at the health needs of children,” he said.
Alex Munter introduces THRIVE project co-chairs,
(L to R) Anne Huot andDr. Lindy Samson.
Mr. Munter explained that by committing to this project, the LHIN has done two things. First, it brought together data, analysis and a much better understanding of the issues in child and youth health care that did not previously exist. Second, it created a venue for people to come together to discuss those issues. “This is really important,” he said. “You’ve brought people together to think about what the problem is, and now that venue can move people to thinking about what the solutions are.”
The project’s co-chairs, Dr. Lindy Samson (Chief of Staff at CHEO/OCTC) and Anne Huot (Executive Director of OCTC Services) presented a summary of the report’s findings to the LHIN Board.
The objective of the THRIVE study was to outline a 10-year capacity plan for children and youth health in the Champlain region that provides:
- An analysis of the child and youth population
- An inventory of health services for children and youth in our region
- Service-need projections
- Models to optimize integrated care.
The approach for doing this work was three-fold: data analysis, consideration of previous planning work, and stakeholder consultations. Key findings of the capacity plan included:
- Child/youth health and service use varies across the region
- There is a need for more collaborative, connected care, especially for youth entering the adult system
- Support services and resources for families need to increase substantially, now and over the next 10 years
- We need a separate home-care strategy for children and youth
- Planning and delivery of developmental and rehabilitation services should be better integrated
- More data are needed to measure and improve the LHIN’s child and youth health system performance
- There needs to be increased access to enabling technologies to improve care delivery
- Stakeholders repeatedly spoke about the current fragmentation in care, and the urgent need to enhance access to integrated services, particularly in the community.
The Board accepted the THRIVE capacity plan, and requested the development of an implementation strategy to fulfill its recommendations. The LHIN Board will review the strategy once it is complete.
This work supports the LHIN’s strategic direction of access, ensuring health services are timely and equitable.
Fourth Quarter 2016-17 Performance Report
Brian Schnarch (Champlain LHIN Special Advisor and Manager, Health System Performance) presented the LHIN’s most recent performance report. The report provides important insight into how well Champlain’s health-system is working, based on 14 indicators provided by the Ministry of Health and Long-Term Care.
These indicators are part of the Ministry-LHIN Accountability Agreement, and include wait times for various services, the number of patients who make repeat visits to the emergency department for mental health and addictions issues, and the number of people in hospital waiting for an alternate level of care in the community.
During the last quarter of 2016-17, the Champlain LHIN met or was close to meeting targets on a number of its indicators, including wait times for hip and knee replacements, and home nursing care. MRI scan wait times were long for people with less urgent needs, but appropriate for those who were urgent.
The indicator furthest from its target was related to wait times for home personal support visits. From the previous quarter, it went from 85% to 31% of target. However, Mr. Schnarch clarified that many clients, in fact, came off the wait list and received personal-support service during this time due to extra funding.
“This is actually good news,” he said. “Clients are only counted in the performance indicator when they receive service and are no longer on the wait list. When people who have been waiting for a while get the service, the performance indicator looks temporarily worse. Once we work through the backlog, so to speak, this indicator will improve.” In the discussion that followed, the Board expressed its concern about the number of people on the wait list for home personal support visits, and the options available to reduce that number as the LHIN moves forward.
The performance report supports the LHIN’s strategic direction of sustainability, increasing the value of the health system for the people it serves.
Voluntary Integration: Community Support Services in Eastern Champlain
The primary mandate of the Canadian Red Cross is to deploy humanitarian efforts on a large scale, including providing emergency and disaster services and first aid and CPR training. In December 2016, and to support this primary focus, the Canadian Red Cross Society informed the Champlain LHIN that it would work towards a voluntary integration with another agency and cease to provide its LHIN-funded community support services to clients across much of Ontario. Specific to the Champlain LHIN, the Red Cross would no longer deliver community support services from its Cornwall branch to approximately 1,250 clients in the following areas of care:
- Assisted Living Services –High Risk Seniors
- Non-Urgent Transportation
- Supportive Housing
- Attendant Outreach.
The next step was to ensure these services would be transferred to another LHIN-funded agency with minimal disruption to the clients who needed them. Carefor Health and Community Services was in a strong position to meet these clients’ needs, as it already offered the above services, and more, as part of its extensive network of home health care, community support, palliative and end-of-life services. Carefor does this work throughout Champlain. In the eastern area of the region, Carefor Eastern Counties serves nearly 17,000 clients. Specifically, Carefor has an office in Cornwall and satellites in Hawkesbury, Alexandria, Lancaster, Winchester, Finch, and Ingleside.
The agencies completed due diligence for a voluntary integration under the Local Health System Integration Act. Final approval rests with the Champlain LHIN Board. To minimize the impact of the change, the Canadian Red Cross Society – Cornwall and Carefor worked together to support a successful transfer of services. The two agencies conducted this work with guidance and support from Champlain LHIN staff, including Colleen Taylor (LHIN Senior Accountability Specialist) and Christine Gagné-Rodger (LHIN Sub-Region Director for Eastern Ottawa and Eastern Champlain).
Progress to date has included developing and delivering comprehensive communication and community engagement strategies for volunteers, clients, staff, partners, and the Ministry of Health and Long-Term Care.
Clients’ concerns centred on understanding when the changes will occur, and maintaining existing relationships with their workers. The LHIN Board was assured that every effort would be made to preserve these relationships, and also, that Carefor has the capacity to maintain Francophone services to French-speaking clients.
Other work has included:
- Establishing detailed integration plans, including risk mitigation strategies. For example, client safety and quality is paramount to both agencies – and plans are in place to minimize any disruption to service. Client privacy and information security requirements were also met.
- Preparing clients for transition, and
- Finalizing detailed plans for transferring services.
The Board voted unanimously to allow the integration to proceed. To that end, on March 31, 2018, the agencies will have completed the transfer of services to Carefor, at which time the Red Cross will no longer offer them, and will cease to be a Champlain LHIN-funded health service provider.
Update on Health Links Progress and Prospects
Cal Martell (Champlain LHIN Vice President, Integration) and Sabine Mersmann (Pembroke Regional Hospital Vice-President, and Champlain Health Links Coordinating Council Co-Chair) presented an update on the LHIN’s action plan on the expansion and sustainability of Health Links in the region.
In the Champlain region, 5 per cent of the population consumes approximately 65 per cent of all health-care resources. Most of these services are hospital-based, and can be costly. Health Links is an approach to team-based care that provides better and more efficient, coordinated care for these patients who have high-needs.
As of June 30, 2017, there were 1,370 patients with high-needs benefiting from the Health Link approach. The aim is to increase this number to 4,370 patients by the end of fiscal year 2016-17, and to 10,000 patients by the end of 2018-19. This represents an ambitious goal to spread the benefits of the Health Link’s approach to some of our most vulnerable people in the region. Much of this will be achieved by realigning existing human resources who already serve these populations.
Primary care engagement is also a critical factor for success in Health Links. Currently, 570 primary care physicians have patients participating in the Health Link approach to care coordination, up from 160 last year. This reflects more than 90% of those required by end of 2018-19.
|Cal Martell and Sabine Mersmann provide
an update on Health Links
Using a single data-system that supports coordinated care planning and delivery is also important. In fact, all Champlain Health Links have moved to a common electronic platform for coordinated care plans, called the Client Health Record Information System (CHRIS) / Health Partner Gateway. “We are one of the few LHINs who’ve transitioned all of its Health Links to a common platform,” said Mr. Martell. “This is critical - not just for the health teams to better manage client information - but also for us to evaluate and manage Health Link performance,” he said.
“For the most part, the foundations for success in reaching this year’s goal are in place,” Mr. Martell continued. “These include resources for care coordination, technology, and primary care engagement. Our risk is with ensuring that all organizations and people are able to deliver on their commitments. In some cases, the LHIN and other partners will need to provide support to address barriers, and in other cases, the LHIN will need to manage performance in different areas.”
Next steps are to use the LHIN’s sub-region integration work to advance the Health Link approach to care. In particular, the LHIN is working with partners and providers to connect home and community care services to the Health Links approach.
Health Links aligns with the LHIN’s strategic direction of sustainability, increasing the value of our health system for the people it serves.